High Dose versus Low Dose Corticosteroids in COVID-19 patients: a systematic review and meta-analysis

ABSTRACT

Objectives: The clinical efficacy of corticosteroids remains unclear. The primary aim of this systematic review and meta-analysis was to evaluate the use of high dose versus low dose corticosteroids on the mortality rate of COVID-19 patients. Design: Systematic Review and Meta-analysis Setting: Electronic search for randomized controlled trials and observational studies (MEDLINE, EMBASE, CENTRAL) Participants: Hospitalized adults ≥ 18 years old who are SARS-CoV-2 PCR positive Interventions: High dose and low dose corticosteroids Measurements and Main Results: A total of twelve studies (n=2759 patients) were included in this review. Our pooled analysis demonstrated no significant difference in mortality rate between the high dose and low dose corticosteroids groups (n=2632;OR 1.07 [95%CI 0.67, 1.72], p=0.77, I2=76%, trial sequential analysis=inconclusive). No significant differences were observed in the incidence of intensive care unit (ICU) admission rate (n=1544;OR 0.77[95%CI 0.43, 1.37], p=0.37, I2= 72%), duration of hospital stay (n=1615;MD 0.53[95%CI -1.36, 2.41], p=0.58, I2=87%), respiratory support (n=1694;OR 1.51[95%CI 0.77, 2.96], p=0.23, I2=84%), duration of mechanical ventilation (n=419;MD -1.44[95%CI -4.27, 1.40], p=0.32, I2=93%), incidence of hyperglycemia (n=516, OR 0.91[95%CI 0.58, 1.43], p=0.68, I2=0%) and infection rate (n=1485, OR 0.86[95%CI 0.64, 1.16], p=0.33, I2=29%). Conclusion: Our meta-analysis demonstrated high dose corticosteroids did not reduce mortality rate. However, high dose corticosteroids do not pose higher risk of hyperglycemia and infection rate for COVID-19 patients. Due to the inconclusive trial sequential analysis, substantial heterogeneity and low level of evidence, future large-scale randomized clinical trials are warranted to improve the certainty of evidence for the use of high dose compared to low dose corticosteroids in COVID-19 patients. Keywords Graphical Image, graphical